Because testosterone replacement therapy is sometimes considered a “new” therapy, many patients ask us this question: “does my health insurance cover testosterone therapy?”
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Most health insurance providers will cover most of the cost of testosterone replacement therapy for men, as long as you can demonstrate the need.
Of course, the amount your insurance covers varies from provider to provider, and it also varies based on your specific health plan and other variables, like your deductible.
Although we cannot guarantee that your insurance will cover the cost of your testosterone replacement therapy, we can at least help you start the process with a free consultation or a simple call to your insurance company.
Your health insurance company may have already approved you for testosterone replacement therapy if you have certain medical conditions or diagnoses from a doctor. Depending on the insurance company, these conditions may include the following:
- a pituitary tumor
- klinefelter syndrome
- kallman syndrome
Other conditions, such as having had a prostatectomy, may also prevent you from needing tests to show low testosterone levels.
for men: how does health insurance cover testosterone therapy?
We will be sure to verify your insurance benefits with your health insurance company to see if insurance will cover the cost of your therapy.
Unfortunately, during your free consultation we cannot guarantee that insurance will cover the cost, and coverage may vary from provider to provider and insurance plan to insurance plan.
The main purpose of the consultation is to assess your low testosterone level and answer all of your questions.
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Most insurance companies require you to prove that you need therapy. in fact, many health insurance companies require you to meet various standards before they will pay for therapy.
Generally, health insurance companies want you to take two blood samples, each indicating low levels of free or total testosterone, on two separate days, before 10:00 am. what constitutes low testosterone can vary between insurance companies.
one of the services we provide is the testosterone test. We help establish the criteria that your health insurance requires through several simple blood tests, the first of which costs only $150.
once we get the results of both blood tests, we can pass the information on to your insurance company.
You may also have been diagnosed with low testosterone by your primary care physician or a specialist; we can work with that too, but we always make sure to do our own blood tests and confirm the work of others.
does health insurance cover testosterone therapy for women?
again, it all depends on your health insurance company, but insurance generally only covers testosterone for women who have specific medical diagnoses.
Why does health insurance sometimes cover testosterone therapy for men but not for women?
the answer lies with the fda.
Unfortunately, the FDA does not currently consider low testosterone to be a diagnosable condition for women in and of itself.
However, health insurance often covers the cost of testosterone replacement therapy for you if you’ve had prior treatment for certain types of breast or breast cancer, and there may be other instances where your specific insurance plan covers the cost.
So, does health insurance cover testosterone therapy for women? it usually depends on your plan.
We will check with your health insurance provider to find out exactly what is and is not covered.
does health insurance cover testosterone therapy? generally yes. but what if it isn’t?
Testosterone therapy is usually covered by your health insurance if your health care provider can demonstrate the need.
However, not everyone has health insurance.
And sometimes, even when you have health insurance, you may have to pay out of pocket for one reason or another. For example, your hormone levels may not technically be low enough to demonstrate a need to your health insurance company, but you may still experience symptoms.
Fortunately, the cost of testosterone replacement therapy is very reasonable, even when paying out of pocket.
Usually $299 a month is enough to cover the cost of weekly testosterone injections, injections you can get quickly and easily, without long waits. We also offer flexible hours and multiple locations, giving you the ability to receive therapy when and where it works best for you.
Most of our out-of-pocket patients find that the benefits of feeling happy, healthy and like themselves again far outweigh the costs – they see the value in therapy.
To find out if testosterone replacement therapy is right for you, schedule a free consultation with us today.